Science Speaks is covering the 49th Union World Conference on Lung Health in The Hague, Netherlands this week.

THE HAGUE, Netherlands – In Mumbai, the largest city in the world’s highest TB burden country, more than half of people living with active tuberculosis disease go undetected and undiagnosed every year. Much of the failure to adequately detect TB cases stems from a dependence on the private sector for health care – more than 70 percent of Mumbai’s TB patients seek care in the private sector. It is a sector that is plagued by suboptimal quality issues, Lal Sadasivan with PATH said here today.

“Some doctors are qualified, some are self-proclaimed doctors or healers,” he said. On average, patients visit six to nine different providers before being diagnosed and placed on treatment, he said. Half of the patients getting treated under the National TB Control Program were first treated by a private practitioner.

In 2015 the public sector reported 30,000 cases of TB while the private sector reported fewer than 3,000, Sadasivan said. To address this massive gap, the Indian government launched the Private Provider Interface Agency as part of its 2012-2017 national strategic plan on TB, aimed at strengthening the private sector’s role in providing universal access to TB services.

Four thousand private providers, about half of which were ayurvedic and homeopathic providers, 300 laboratories and 400 pharmacists in Mumbai received training on screening, using GeneXpert to diagnose TB, adequate treatment and other activities aimed at promoting standard practices, Sadasivan said.

Researchers saw a ten-fold increase in the number of TB case notifications coming from the private sector, Sadasivan said, jumping from 2,900 notifications to 30,000 last year.

While researchers found there were five GeneXpert machines in the private sector, none of them were being used due to the high cost of cartridges and maintaining the machine, he said. When the Indian government subsidized the test, private providers conducted over 55,000 tests and found 20,000 active infections, including 5,000 rifampicin-resistant cases, Sadasivan said.

In the city that reported 12 cases of TB that were totally resistant to all forms of antibiotics in recent years, that’s welcome news, researchers said.

The next step is to scale up this model to the national level – an essential component of India’s strategy to achieve global TB elimination goals by 2025, five years ahead of the 2030 target, researchers said.